Finding a Nursing Home
Anywhere in the U.S., Its Rating and Steps to Take if You Have a Complain

(10/1/15)- The following is an
e-mail that we received from Landon Biehl to
Harold one of the editors at therubins that
contains links to 2 sites that were helpful to Landon in making decisions
regarding the placement of a loved one in a nursing facility. We thanks
Landon for taking the time to send us the e-mail

I
wanted to follow up from my email last week, since I haven't heard back
from you. After searching around for various care
information for my grandmother, I came across your website. Placing
her in a home has not been easy. I found your website to be useful in
providing information about caring for our elders.

I
wanted to share two resources that have been really useful in the past few
weeks:www.nursinghomesafety.orgprovides information
and statistics for families to use regarding proper placement into nursing
homes. Also, www.formyparent.com/eldersafetyhelps to locate nursing
care facilities in your area, and shows health scores, ratings, number or
nurses on hand, reviews etc.

Would
you be willing to help me make an impact, by sharing at least one of these
resources with your website? I think they could really help.

I
look forward to hearing from you!

Best,Landon

(8/7/16)- The Centers for Medicare &
Medicaid Services (CMS) on Wednesday released overall hospital quality star
ratings on the Hospital Compare website. While CMS already posts quality
data on hospitals and other kinds of healthcare providers, this is the
first time it has published the overall hospital ratings, which rank
institutions on a scale of one to five stars

(6/21/15)- New federal
guidelines stipulate that nursing homes are graded on the percent of their
dementia patients receiving antipsychotic medications. That figure becomes
part of their rating on Nursing Home Compare, a tool from Medicare that
helps consumers compare information about nursing homes.

(2/24/15)- As we noted in our item dated 2/15/15 below, the Centers for
Medicare and Medicaid Services (CMS) has readjusted the methodology it uses
to award stars on its NursingHomeCompare.gov website that is the gold
standard used by most consumers in evaluating nursing homes.

As a result of this readjustment only about 50% of the 15,000 nursing
homes being evaluated received 4 or 5 stars, as opposed to the
approximately 80% that attained this level before the change. The number of
homes receiving one star in the quality area increased from 8.5% to 13%.
The website gets about 1.3 million viewers a year.

The changes that took effect were mainly aimed at two of the 3 major
criteria used to rate the homes on the site. Two of the three major
criteria used to rate operations at homes, namely staffing levels and
quality measure statistics, had been reported by the homes themselves, and
these figures were not audited by the government.

A change was made last October when the federal government required
nursing homes to report their staffing levels quarterly, using an
electronic system that could be verified by payroll data. An auditing
system was also installed that could double check the quality statistics
that the homes were reporting.

The changes led to a decline in the quality measure for 63% of the
homes. The staffing levels fell by about 13% under the new system

(10/29/13)-We at therubins received the following e-mail from Scott
Richards of Carecompare. We took a look at his
site and found it to be an excellent resource as Scott stated in his email.
We highlyrecommend

recommend this site.

Scott Richards<scott@carecompare.com>

Hi,
I was looking to get in touch with someone to suggest a site for
your helpful web sites page. Carecompare (https://www.carecompare.com/)
is a site that specializes in matching up those that need care with those that
can provide it and allows for price and service comparison. I think it
would be a fantastic resource for your page and that it would go great with the
great resources you already have.

Take a look at the site and let me know what you think - I look forward to
hearing back from you.

Best regards,

Scott Richards

(4/2/13)- A new website, www.hospitalinspections.org
, includes detailed reports of hospital violations dating back to January 2011,
searchable by city, state, name of the hospital and key word

(1/22/12)- Here is another recent email that we received at therubins referring to a site that
may be helpful to many or the viewers of this article. The site is: www.seniorhomes.comHow are you doing today? I hope you are having a great
day. I am contacting you because I would love to suggest seniorhomes.com as a
resource for your helpful sites page. SeniorHomes.com is a free resource for
people looking for senior housing or senior care for a loved one or themselves.
With hundreds of expert-written articles, a free care advisor service and a
nationwide directory of assisted living, independent living, and Alzheimer's
care communities, we help people navigate the
difficult issues of senior care. We are an official Google News source for news
related to senior housing and senior care.

I tried to contact you a while ago on nursing homes widget from Caregiverlist, Inc. As the content manager for Caregiverlist, I though(t) your readers might be interested
in our daily nursing home prices which assist in explaining senior care options
and costs. Here is a link to our Widget page where you can grab and post the
nursing home costs and ratings widget. We did contact 18,000 nursing homes
nationwide to secure this information and are the only resource providing
actual costs of nursing homes nationwide:

http://www.caregiverlist.com/Widgets.aspx" target Separately,
if you would like to post a guest blog post, we would welcome the post as a
return favor. Let me know if you have questions.
Thanks,CaiXingliang
Content ManagerCaregiverlist, Inc."

editors note: This site
was created in memory or our mom. We do not have any paid advertisements on the
site. It is strictly a public-service site.

(7/11)- Users of WhyNotTheBest.org can conduct side-by-side comparisons of
more than 4,500 hospitals nationwide, track performance over time against
numerous benchmarks, and download tools to improve health care quality.

(6/30/11)- The Department of Health and Human Services (HHS) has a site that
enables you to compare hospitals, see what the ratings are for various
departments in the hospitals and what to do if you have a complaint. The site
can be located at hospitalscompare.hhs.gov

(11/21/09)- The latest performance data on the process-of-care and hospital
patient experience measures that are publicly reported by the Centers for
Medicare and Medicaid Services can be found on WhyNotTheBest.org. Users of the
site can conduct side-by-side comparisons of 4,500 hospitals nationwide, track
performance over time against numerous benchmarks, and download tools to
improve health care quality.

(6/23/08)- About 1.5 million Americans live in nursing homes,
and about 22% of the 5.3 million people 85 or older had a nursing home stay in
2006. There are an estimated 16,000 nursing homes in this country, and in an
attempt to improve the quality of life within these homes the Centers for
Medicare and Medicaid Services (CMS) is adding a rating system to its database
so that the consumer is helped in evaluating these facilities.

The new rating system will be based on a five star system that the CMS hopes
to have on its site by the end of this year. In addition to this announcement,
the CMS also announced that all nursing homes would be required to have a
sprinkler system in operation by 2013. Up to now, only new nursing homes or
those undergoing extensive renovations were required to have sprinkler systems.

In March 2005, Medicare required all nursing homes without sprinklers to
have battery operated smoke alarms in patient rooms and public areas.

The new rating system will give each nursing home from one to five stars
based on government inspection results, staffing data and quality measures.

The federal and state governments are the largest third-party payers for
nursing home care. Medicare spent $21 billion on nursing homes in 2007, up from
$17.6 billion in 2005.

Toby S. Edelman, senior policy attorney with the Center for Medicare
Advocacy, and advocacy group, said two of the three criteria that CMS plans to
include "are self-reported by nursing facilities and are inaccurate."

(1/28/06)- Investigators from the Government Accountability Office have
concluded in a report that state nursing home inspectors often overlook serious
deficiencies, including life-threatening conditions in the nursing homes that
they inspect. The investigators found pervasive understatement of "serious
deficiencies that cause actual harm or immediate jeopardy to patients."

The harm includes "multiple falls resulting in broken bones and other
injuries, and serious, avoidable pressure sores," according to the report.
Charles E. Grassley (Rep.-IO.) and Herb Kohl (Dem.-WIS.) requested the study.
The report questioned data used by the Bush administration in arguing that its
policies have fostered "significant improvements" in the nation's
nursing homes.

Mainly state inspectors working under contract to the federal government
inspect nursing homes. Federal inspectors visit about 5% of the nation's 17,000
nursing homes each year to validate the findings of the state inspectors. In
the follow up inspections, federal investigators found that in 28% of the
inspection that they conducted between 2002 to 2004,
the state inspectors had missed serious violations in about 28% of the
inspections. This proportion had increased from the 22% found in the years 2000
to 2001

Inspectors found 47,456 fire-safety violations in 2004, an increase of 20%
over the previous year. Medicaid covers about two-thirds of the nation's 1.6
million nursing home residents. Medicaid and Medicare spent more than $67
billion a year on nursing home care.

In its report, the GAO concluded:

States often take weeks or months to start
investigations of harm to nursing home residents.

Much of the information on the federal Web site about
nursing homes contains inaccurate or otherwise unreliable information

The timing of the state nursing home inspections is
highly predictable.

More than 20% of the nursing homes still have no
sprinkler systems

The federal inspectors found that the state quality of inspections varied
greatly state by state. From 2003 to 2005 California cited 6% of its nursing
homes for serious violations. During this same period of time Connecticut found
54% of its nursing homes were cited for serious violations.

(6/28/05)- After a thorough attempt to find the citation for the following
item that we wrote about in this article, we could not come up with the answer.

"A federal court in Washington has upheld the government's right to inspect, cite and sanction nursing homes that endanger their
residents' health and safety. The case arose when the Centers for Medicare
& Medicaid Services (CMS) terminated the Medicare and Medicaid payments for
a nursing home in Florida for failure to correct violations that were found to
exist in the home after several inspections. These violations were said to have
jeopardized the residents' health and safety.

The home had failed to rectify the violations. The CMS then ordered the
home to move all Medicare and Medicaid residents to another facility. The
nursing home fought the termination of the payments and the order to move the
residents in the federal court. The nursing home questioned the
constitutionality of the nursing home enforcement system by the federal
government. The federal court rejected the nursing home's appeal, stating that
the federal government in fact had an obligation to protect the rights of
residents of nursing homes that were being reimbursed for their care by
Medicare and Medicaid."

If any our the viewers of this site are familiar with this case we
would appreciate your forwarding any information that you may have about it on
to us.

(5/26/05)- According to the results of a study done by the Long Term Care
Community Coalition, a nonprofit group that has been quite critical of New York
States' Department of Health for being lenient on long-term care providers, the
state's health inspectors overlook many of the problems at nursing homes in the
state, compared to the federal inspectors who do a much better job.

Although there were only 12 cases that were examined in the study in which
federal inspectors double-checked the work of state inspectors the findings are
quite intriguing. The study also compared national data and found three
significant problem areas in the state. They are:

New York State nursing staff levels fall below the
national level

That New York State inspectors verify fewer complaints
about poor conditions in nursing homes

The numbers of deficiencies identified per nursing home
are less than in 38 states.

Cynthia S. Rudder, the executive director of the Coalition stated: "We
feel all these findings fit together to demonstrate the failure of the
Department of Health's nursing home survey and complaint system and its failure
to protect nursing home residents." There are 120,000 beds in the state's
nursing home system with over 600 homes operating in the state.

Federal inspectors have an average of 7.5 years of experience compared with
state inspectors, who have only less than two years of experience on average.
Homes that receive payments from Medicare and Medicaid are subject to being
inspected by both federal and state inspectors.

(9/24/04)-A paper entitled "Barriers to Effective Enforcement"
studied the penalties assessed against nursing homes for violations of federal
health and safety standards in the last four years. Jerry Sandlin of the
federal Centers for Medicare and Medicaid Services and David Dunbar of the
Georgia Department of Human Resources wrote the paper. One of the conclusions
of the paper was that: "The enforcement process has become increasingly
complex, inefficient, inconsistently applied and demonstrably ineffective in
ending yo-yo compliance and ridding the industry of chronically poor-performing
providers."

The number of nursing homes penalized for violations of federal standards declined
by 18%, to 2,146 in 2003 from 2,622 in 2001. The number of civil monetary
penalties declined 12%, to 1,979 in 2003 from 2,242 in 2000. Nursing homes must
meet federal standards as a condition of participating in Medicaid and
Medicare, from which they received more than $64 billion last year. It is
estimated that Medicaid covers more than two-thirds of nursing home patients.

State inspectors must inspect all nursing home facilities within their
jurisdiction at least once a year under Medicare and Medicaid rules. Federal
officials are supposed to visit at least 5% of the homes to verify the states'
findings. Results of the inspections are available through the Nursing Home
Compare link at www.medicare.gov . According
to the inspector general of the Department of Health and Human Services
consumers should use this site with caution since information was missing or
inaccurate for 19% of the homes.

According to a study done by a unit of AON Corp., a Chicago based insurance-brokerage
company that does business with nursing homes, and
paid for by the American Health Care Association, a trade group for the nursing
home industry, liability premiums for nursing homes are soaring. The study
found that the liability cost per nursing home bed climbed to $2,290 in 2003
from $1,730 in 1999. In determining the liability costs for the homes the study
included both malpractice insurance and litigation costs. The study surveyed
the liability costs of 108 nursing homes in different states.

Because of the large increase in premiums by the nursing homes for liability
insurance, many of them are asking that prospective residents forgo the right
to sue the home and instead must agree to rely on arbitration to settle any
claims against the homes. The rising cost for malpractice premiums has caused
some homes to cut their insurance coverage, or even to drop their liability
coverage to a minimum under the laws of the particular state where the home is
situated.

Currently about 25% of the California nursing homes carry no liability
insurance according to the California Association of Health Facilities, a trade
group. In Arkansas 103 of the facilities have no liability insurance, according
to a survey that was done by the Arkansas Health Care Association that was done
in May 2003.

A private room in a nursing home cost $181,124 a day according to a study
that was done by MetLife Inc., which was an increase of 8% from just 15 months
earlier. On average Medicaid pays $118 a day for nursing home care. The cost
for malpractice insurance has risen about 51% according to the study done by
the AON unit. The study also determined that claims against nursing homes rose
to 15.3 for each 1,000 beds in 2003, up from 13.8 in 2002.

A federal court in Washington has upheld the government's right to inspect, cite and sanction nursing homes that endanger their
residents' health and safety. The case arose when the Centers for Medicare
& Medicaid Services (CMS) terminated the Medicare and Medicaid payments for
a nursing home in Florida for failure to correct violations that were found to
exist in the home after several inspections. These violations were said to have
jeopardized the residents' health and safety.

The home had failed to rectify the violations. The CMS then ordered the home
to move all Medicare and Medicaid residents to another facility. The nursing
home fought the termination of the payments and the order to move the residents
in the federal court. The nursing home questioned the constitutionality of the
nursing home enforcement system by the federal government. The federal court
rejected the nursing home's appeal, stating that the federal government in fact
had an obligation to protect the rights of residents of nursing homes that were
being reimbursed for their care by Medicare and Medicaid.

We have come across many sites that have been set up to help the consumer
become more knowledgeable about what is available at little or no cost when you
are trying to get helpful information about how to deal with some of the
problems of your beloved older relatives or friends. Here are some of these
sites with a brief explanation as to the areas that they deal with:

http://www.caregiver.org-
The site for the National Alliance for Caregiving that is free for your
usage. You can get one-on-one advice from an experienced patient counselor
on caring for an ailing elderly relative or friend. It also rates other
Web sites, books, videos and other products based on topics.

http://www.aarp.org-
The site for the 35 million member organization AARP that lists over
43,000 elder-care facilities and services.

http://www.Medicare.gov-
Opens the governments data-base to you on a
region by region basis so you can find out and compare exactly what is
available to you.

http://seniornavigator.com-
A site started with venture capital money from the now governor of
Virginia Mark Warner after he became aware of the problem when his mother
became a victim of Alzheimer's disease. It deals with the state of
Virginia, and now has over 6,000 volunteers who will help you deal with
the problems of the elderly.

www.abuseneglect.com-Thanks
to one of our viewers we became aware of this excellent site which deals
with the problem of abuse and/or neglect of the elderly. Unfortunately
this is a much greater problem than most of us realize, and this site will
help you know what to do when it happens to someone you care about.

The Department of Health and Human Services announced the launch of a pilot
program in 6 states that will allow the consumers to compare nursing homes in
respect to nine separate measures of quality. The states involved in the pilot
program are: Colorado, Florida, Maryland, Ohio, Rhode Island, and the state of
Washington. If the pilot program works out well it will be expanded to cover
all the 50 states by the end of this year.

The nursing-home data will allow consumers to compare one facility against
another and also compare the nursing homes performance with benchmarks both on
a statewide and national level. Currently there are an estimated 2.9 million
Americans residing in nursing homes. Please keep in mind that these databases can not replace the need to actually visit the facility so
that you can see exactly how the home operates.

Initially the database will cover 6 types of information:

The proportion of residents who have bedsores.

The proportion of residents who are in physical
restraints.

The proportion of residents who have lost too much
weight.

The proportion of residents who are suffering pain.

The proportion of residents who have certain types of
infections.

The proportion of residents who need more help with
daily activities.

You will then be able to compare these numbers to other homes in the state,
or even use the national numbers for comparative purposes. Also keep in mind that
you may request to see the violations book that all nursing homes being
reimbursed by Medicare and Medicaid must make available their violations book.
The data is based on information supplied by the nursing homes themselves.
Homes that knowingly submit false information can be prosecuted criminally for
fraud. The government said it had adjusted the data to reflect the physical and
mental condition or the residents of the home.

In our article "Selecting a Nursing Home" we discussed the
importance of finding a Nursing Home that not only is well qualified, but that
is also convenient for you to travel to. How do find such a place? You would
also like to know if the Home is in compliance with all Medicare and Medicaid
regulations. Is the Home a Medicare and Medicaid certified Home? The
information available on this site has recently been expanded to include
everything from the make up of the residents of the
home and a comparison with other nursing home both statewide and throughout the
United States. The database on this site is as extensive as anywhere on the
Web. Its address is:

New York State OmbudsmanInformation on nursing home complaints that have been resolved at a lower
level than those reported to licensing can be obtained. The ombudsman tries to
resolve the concerns at the lowest level, therefore
these would not be shown on the Medicare nursing home surveys for example. http://www.ombudsman.state.ny.us
Martha Haase, State LTC Ombudsman, NY State Office
for the Aging
(518) 474-7329
Thanks to Linda Kelly for emailing this one in to us

President George W. Bush's spokesman announced that the administration had
rejected the plan discussed below to ease regulatory requirements involving
nursing homes. The plan had been drawn up by the Department of Health and Human
Services. According to the spokesman, Ari Fleischer "We're going to beef
up and strengthen nursing home regulations.We're
working to strengthen accountability". He futher
stated that the plan discussed below had been "rejected out of hand"
more than 2 weeks ago, because "the president believes very strongly that
it's a federal responsibility to protect seniors in nursing homes." We are
relieved to hear these comments and hope that actions to back these statements
will follow shortly.

The September 7, 2001 edition of the N.Y.Times had
an article written by Robert Pear entitled "U.S. May Ease Rein on Nursing
Homes". The sub-title was "Administration Would Reduce Inspections
and Penalties". According to the article the present law requires that
nursing homes participating in Medicare or Medicaid must be inspected once a
year on the average, with no more than 15 months between inspections. The
government is considering changing this to a two-year interval.." The Bush administration says that it wants to
modify the enforcement process to 'rescind some sanctions that are inflexible
and often considered too harsh' ".

Under the present rules, penalties are automatically assessed if the
inspectors find deficiencies that cause harm or immediate danger to patients in
two consecutive visits. The rules further require that the government stop
payments to nursing homes that fail to comply with federal health and safety
standards within 6 months of the inspection. The Bush administration would ease
this penalty. The government spent $39 billion on Medicare and Medicaid
payments to over 17,000 accredited nursing homes that cared for 1.6 million
elderly or disabled people in 2000.

No matter how good any nursing home may be you will always observe something
that you feel calls for corrective action. What are the procedures that you
should follow to try and get the complaint resolved? There is no one correct
procedure to follow. You must use your best judgment, but we will suggest
several possible avenues for you to follow to help you resolve it.

Your first line of communication is with the Registered Nurse in charge of
the resident's floor. If you are not satisfied with the response the next level
to go to try and resolve the problem is the Medical Doctor who is in charge of
the resident's floor. Remember that the Social Worker should be consulted also,
because he/she is the resident's contact person with the administration.

If you are still not satisfied with the results contact either the
Supervisor of Nursing Care at the home or the Medical Director to voice your
problem. If still not satisfied with the results contact the Head of
Administration at the home. At the same time advise the ombudsman at the home of
your problem. This individual is your representative on behalf of the state,
who is there to protect the resident's interest and well
being.

If you still feel that your complaint is not being properly addressed there
are governmental protections available to you. If you have a Nursing Home
complaint in NYC call 1-800-425-0316; Nassau-Suffolk call
1-800-425-0323. Keep in mind that the Health Care Finance Administration is the
Federal government's overseer of Nursing Homes in the United States. Their
telephone number is 1-800-MEDICARE. Their web site is www.medicare.gov

Suppose you are still unsatisfied with the results. Do you take the problem
to an attorney? On Friday March 26, 1999 the Wall Street Journal had an article
written by Michael Moss wherein certain ethical questions were raised
concerning an attorney- Better Nursing Home Advocacy Group relationship. It
seems as if the law firm of Rosen & Newey in Houston, Texas paid for the
toll free number that received complaints telephoned to United People Nursing
Home Care.

It was also shown that the law firm answered the toll free number first and
then forwarded the call to the advocacy group. The law firm also made donations
to the advocacy group and in fact was their main financial support. The article
also stated that the law firm also paid for the advocacy group's web site. It
was also the procedure followed by a few other law firms to do the same with
some other advocacy groups.

Thus the ethical question arises was the law firm violating the code of
ethics in these cases? Were the donations from the law firms to the advocacy
groups in fact rebates? We do not wish to judge any case where we do not have
all the facts in front of us. We point these items out to you so that you may
be better informed on these topics. We certainly are aware of all the good work
done by many of the advocacy groups. They continue to be part of the safety
network set up to protect the elderly. See our articles on Helpful
Web Sites and Organizational Resources for
information about assistance that is available to you.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN
SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting
a Nursing Home"